X-Message-Number: 31057
Date: Sun, 14 Sep 2008 19:58:34 -0700 (PDT)
From: William O'Rights <>
Subject: Silly and Foolish

Steve Harris
>Comment: Radiation doesn't cause nausea unless the beam hits 
>your gut,

Actually Steve, Radiation therapy to the stomach, abdomen, or pelvis can often 
cause nausea and vomiting. Gastrointestinal toxicity can occur following 
irradiation of thoracic, abdominal, or pelvic malignancies whenever normal 
gastrointestinal structures are located within the radiation therapy field. 
Radiation-induced nausea and vomiting typically occur within 24 hours of 
treatment, and over 80 percent of patients undergoing radiation of the upper 
body will develop symptoms of nausea and vomiting. The gastrointestinal side 
effects of RT include early acute toxicity, such as diarrhea and nausea, that 
are experienced during or shortly after the completion of a course of therapy. 

> which today's very fine beams can be adjusted not 
>to do, if you like.

That assumes that one has the options such as CyberKnife, which is a 
comparatively less invasive, more precise radiation technique that can deliver 
concentrated and accurate beams of radiation to any site in the body. This 
system combines robotics and advanced image guidance cameras to locate the 
tumor's position in the body and deliver highly focused beams of radiation that 
converge at the tumor, avoiding normal tissue for the most part. It is a fairly 
impressive and successful method used to treat spinal tumors or tumors at other 
critical locations that are not amenable to open surgery or radiation, as well 
as to treat medically inoperable patients.


And of course there is Proton beam radiation therapy. This is one of the most 
precise and sophisticated forms of external beam radiation therapy available 
that I know of. The advantage of proton radiation therapy over x-rays is its 
ability to deliver higher doses of shaped beams of radiation directly into the 
tumor while minimizing the dose to normal tissues. This leads to reduced side 
effects and improved survival rates. 

There are not that many treatment centers worldwide for Proton beam radiation 
therapy, the closest that I am aware of is the Northeast Proton Treatment Center
at Massachusetts General Hospital in Boston. I unfortunately live in Maine, so 
these two options are equally not available to me, whether I like it or not. 


I was told that the only machine available to me at the time was 
Three-dimensional conformal radiation therapy (3D-CRT). 3D-CRT is a technique 
that uses imaging computers to map the location of a tumor, but it old tech. It 
is possible to reduce radiation damage to normal tissues surrounding the tumor 
by up to 50 percent, but that's not the kind of numbers one wants to hear when 
their tumor is resting up against the heart, esophagus, and lung. I was told to 
expect not only Radiation-induced nausea and vomiting,but radiation issues in my
esophagus.


At the time that was written my tumor was still fairly larger. It was to later 
shrink to a small 1cm, and I found out that Intensity modulated radiation 
therapy (IMRT) was available for me to use. IMRT creates a shaped radiation 
beam, delivering high doses of radiation to the tumor and significantly smaller 
doses of radiation to the surrounding normal tissues, not as well as CyberKnife 
or Proton beam radiation therapy, but good enough to blast a 1cm tumor without 
too much surrounding tissue damage. Unfortunately by then, the doctors adopted a
wait and see approach, 40 days later we were back to square one with an 11.4cm 
tumor.

> Otherwise it's nearly without side 
>effect when administered to lung or bone in a narrow beam. 
>There is typically some redness of the skin akin to mild 
>sunburn, but that's all.


Actually that not quite accurate. The most selective Radiation cannot 
selectively target the tumor without some damage getting there so even the most 
sophisticated machines have the issue of hitting normal cells within the 
radiation field, and those cell suffer damage, leading to potentially serious 
side effects. Although radiation is directed at the tumor, it is inevitable that
the normal, non-cancerous tissues surrounding the tumor will also be affected 
by the radiation causing damage. The radiation beam does not magically miss all 
of the healthy tissue.  Radiation-induced fibrosis, a serious late effect of 
radiotherapy, is mainly characterized by changes in the connective tissue of the
lungs. Sort of a concern of mine. The lung is among the most radiosensitive 
organs, and the risk of severe side effects seriously compromises the whole 
picture. Radiation pneumonitis (inflammation of the lung) is a common acute side
effect occurring many patients

 treated for lung cancer between one month and six months after radiotherapy. 
 Radiation therapy-induced fibrosis is associated with scarring of the lung and 
 typically occurs months to years after radiotherapy.

> It may not 
>change survival time, but it will shrink any tumor it's 
>directed at, and will help pain associated with tumor 
>expansion, which is the typical way that tumors generate 
>pain. It should also delay (but not prevent) pneumonia from 
>tumor blockage of lung airways.


Well Steve, if it doesn't change the survival time than it is wholly irrelevant,
because that's all I really care about.

>It would be silly to refuse it for a bad reason.

And Foolish to use it for the wrong reasons;)
Live Long and Well
William O'Rights

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